New Data on Biologic Treatment Safety in Solid-Organ Transplant Recipients

A recent systematic review of the safety of biologics for the treatment of autoimmune/inflammatory diseases in recipients of solid-organ transplants found that no therapeutic or demographic factors were associated with the occurrence of infection.

The review, which assembled the largest number of published reports on the subject within the Medline, Embase, and Cochrane databases, sought to define the complications that could potentially impact those who have received solid-organ transplants and have an autoimmune/inflammatory disease. The study reviewed literature from the three databases up until January 10, 2020, to identify all published cases and series reports.

Included in the results were 57 articles that totaled 187 patients (141 liver, 42 kidney, 3 heart, and 1 liver-kidney transplant recipients). Of these patients, the most common indication for biologic therapy initiation was inflammatory bowel disease (80.7%), followed by rheumatic diseases (7.5%), hereditary periodic fever syndromes (5.9%), and psoriasis (4.8%). The most commonly prescribed biologic agents were tumor necrosis factor α inhibitor monoclonal antibodies (70%) and etanercept (7.5%), vedolizumab (27.3%), and anakinra (6.9%).

Median treatment duration was 12 months. Over the course of treatment, 54 (28.9%) patients experienced an infection through 88 recorded events. Further analysis revealed infection was not associated with any therapeutic or demographic factors. The authors found that 16 (8.6%) patients developed malignancies, and five (2.7%) patients experienced an acute graft rejection. Nine deaths (4.8%) were reported within the patient population.

This robust data compilation assessing the effects of biologic treatments in patients with both solid-organ transplants and a chronic inflammatory disease diagnosis is crucial to understanding the safety risks, but it concluded that further comparative studies are still needed.

Reference
Meyer F, Weil-Verhoeven D, Prati C, Wendling D, Verhoeven F. Safety of biologic treatments in solid organ transplant recipients: a systematic review. Semin Arthritis Rheum. Published online August 26, 2021. doi:10.1016/j.semarthrit.2021.08.013